Loading...
29-106 29-284-001 N/F RICHARD F. LEBEAU BOOK 3914 PAGE 198 CIRS 269.11 PLAN BOOK 74 PAGE 46 N29'S7'38"E 1 � � /V28 02'38"E 750. 00 -�-- N Z �p -50 ' ° Cn 29-106-001 29-105-001 M N r PARCELI Ll 21 ,440. sq. ft. 29— 0.492 acres L � � 4 � PARLE] PAVE HOUSE 16,.6&8.';-4C DRIVEWAY (-- 0.38.3 ac t L z CD °' rn � FGU',I D % N 1" .iRQN WIPE . . D`J N 0.4' N4'/*41'0i"W 0.85' N 2942673.14 FROM A�NGLE POINT E 332879.26 _ S33 02'04"ly 150. 00' --- ��--- CIRS - UP# -52 EDGE OF PAVEME RYAN ROAD A DEC. 5, 1963 COUNTY ALTERATION PLAN BOOK 65 PAGES 2 & 3 EDGE OF PAVEMENI BOOK 1431 PAGE 353 1 w w c 3 a � a = t r .1 a m t r � O 1 . A , w W V 0 � _ -U 0 i ( I o m m 1 1 O Yl V our O •ti I I - O i Iz- i 1 -' v �\ o A3 I D�L�lm a ; _ y u S n v... 1�. k b , ,'Y k yr" s ,3I ISSUE DATE 0511012007 PRODUCL'R • THIS CER'T'IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Finch& $1—ras Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE I-IOLDER.TI-IIS CERTIFICATE 6 Campus Lane DOES NOT AMEND,EXTEND OR ALTER TI IE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton,MA 01027 COMPANIES AFFORDING COVERAGE INSURED Bill Willard Inc P O Box 60307 COMPANY A A.I.M.Mutual Insurance Co Florence,MA 01062 LETTER C O,VLI2ACiL5 W � mg � e IS 3 d f fin, 3 f 3 I >> ,, �3. 3n 33 �..;�. THIS IS TO CERTIFY TI IAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TILE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITI1 RESPECT I0 WI(ICI I TI11S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI,L T iE TE'RMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t O TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMI'T'S LTR DATE(MM/DD/YY) DATE(MMIDD/VY) GENERAL LIABILFPY GENERAL AGGREGATE S PRODUC]S-COMI'/OP AGG. S �C'OMN1LRCIAL 6LNLRAL LIAUILI'I V 1'L'RSONAL ti ADV.INJUILY S O CLA IRIS MADI,=OCCUR EACH OCCURRENCE $ OWNER'S&CON'FRACI OR'S PRO 1. FIRE DAMAGE(Anyone tire) S �_. NI ED.EXPENSE(Anyonc person) S AUTOMOBILE LIABILITY CON i BINED SINGLE LIMIT ANY AUTO BODILY INJUM' ALL OWNED AUTOS (I'cr persouj 5 SCHEDULED AUTOS I IIRED AUTOS NON-OWNED AUTOS BODILY INJURY 5 GARAGE LIABILITY (Per accident) PROPERTY DAMAGE EXCESS LIABILI"rl' EACH OCCURRENCE S UMBRELLA PORK( AGGREGATE S 01 IJI3R THAN UMBRELLA fOILNI WORKERS COMPENSATION AND STATUTORY LIMITS OTHER EMPLOYERS LIABILITY X TIIE PROPRUIOR/ EL EACII ACCIDENT $ 500,000 A PAILNERS/EXF('UTIVL "1`1`1"`1"ARE 7019830012006 10/08/2006 10/08/2007 EL DISEASI -?0LICY LIMITS 500,000 X INCI. =1eXCL II.DISI:nsr;--I.ncn 500,000 I:nnPLOYr;E•. COMAIEN"CS/DESCRIPTION OF OPERATIONS OR LOCATIONS: f, ao— ,...SI'4"a.)Ir t�', SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON T1IE COMPANY,ITS AGENTS OR REPRESEN'T'ATIVES. J AUTHORIZED REPRESENTATIVE OP ID C DATE(MM/DD/YYYY) ACQCR .. CERTIFICATE OF LIABILITY INSURANCE DANIE50 06/28/06 PRODUCER • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Reynolds, Barnes & Hebb, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 166 Test Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 4889 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pittsfield MA 01202 Phone: 413-447-7376 Fax:413-443-7608 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Safety Indemnity Insurance Cc 33618 Dan Whiteley, Inc. NSURERB: Central Insurance Company 20230 Whiteley Electric INSURER C: 52 Cottage Street Easthampton MA 01027 INSURER D: IN. URER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSKA= POLICY EFFECTIVE POLICY EXPIRATION LTR INSRI TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2000000_ COMMERCIAL GENERAL LIABILITY BOP 7938625 07/01/06 07/01/07 PREMI�MAS aoccurence) $ 100000 CLAIMS MADE 1XI OCCUR MED EXP(Any one person) $ 5000 B X Business Owners PERSONAL&ADV INJURY $2000000 GENERAL AGGREGATE $ 4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 6000000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ A ANY AUTO 3945474 07/01/06 07/01/07 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ 250000 X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ 500000 NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 100000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY "- - B ANY PROPRIETOR/PARTNER/EXECUTIVE WC7938626 07/01/06 07/01/07 E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1000000 OTHER 7 BUILDING 516000 PROPERTY 50000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Electrical Wiring CERTIFICATE HOLDER CANCELLATION TOWNB-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL j V'C// Towne Builders /e �j ( , IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR / , n �8 ___ _-___- REPRESENTATIVES. Easthampton MA 01027 AU JiQRIZE REPRESENT VE � ACORD 25(2001108) �O_'YJ�A�'� ©ACORD CORPORATION 1988 y op 10 DATIP(PRAWLIffyi I CERTIFICATE OF LIABILIT"t INSURANCE n 5!14 107 gvc- 13.1.3 A6[bEll.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR market Placct ALTER THE COVFRAGE AFFORDED BY THE POLICIES BELOW If smF-RS AFFORDING 00s/r--RAGE NAIC# INSURPR& H►nOVCr InSUZall'Oe COMP A.11m. bimtutl 71UN&S=106 CO. INSURrR C: Va Mark Li%va-' ;,ey Son Trucking st r #41pv C. Mask LaValley 2107 .13ylveoter qad rINSUREP D' r1orefice MA 01362 COVERAGES -vvrrKSTANDI[qr, HAVE BEEN ISSUED 1-0 THE INSURED WWED ASOVF FOR THE POLICYPERIC00"01CATED.�jm THEPOLICIES OF INSURANCE,i7S 7�:Tj ANY RMUIREMENT,7El.RS-A ORCL'.)MUMCN OF ANY UCIN-i RACI OR CITHER DOCUWNT WITH R.ESPEt.TTO WHICH THIS[:ERTIFICATI--WAY BE ISSUED OR WNY FFRTMN.71E:iN$URANCL AFFORD"o BY THE POLICIES DESCRIBED HEW-IN IS SUEJEOTTO ALL THL i&RNir,,WrLuSI0N$AND CQNDITIONS OF SUCH WOLICIES,AGGREGATE LRA TS SHM(` MAY HAVE SE0 REDUCED 0Y PAID CLAWS. Tw Tou p;e-m1EN-rxp -R 0 PULQf NUMLIC plo ryy) I LINKS LTR NGRU.,.. OF INSURANCE GENERAL UAZILITY CA H CCl.:URW::N(,S $ :1000000 C CCIIAMIERC�AL r4r.N'EliALUAHILITY pkiuir7shj:a•�ur.ncLl. 300000 C.AIMSAAr` I X ='R f MZO EXP;Any—1--) 1 x000 PURSQNALLADvluj"'Ry, 1$1000000 GENERAL AQQREGATr_ s2000000 0 6 0()0 I GIEN'L ACGWiCA.TK LIW."APPL16—; PO-i: PROI)uc m,-complop Ac;,? � ;-.LEI PRO. I POLICY AUT omoo"-LIABILITY COMDINEO rl.4LE LINUT 1 At-V AQ70 09/26/06 0-9/26/07 (Es ftccld*'Q I ALL OWNED ALITJS ULYiNJUN-Y X CHL-X'Lpr)AUTOS f Per person', HIR-KAJ10S NXALY Dowmt PROP IER'l-l'DAMAGE (per occ.40rr� GARAGE LIABILITY AUTO ONLY-CA ACCIM-N7 S k,Y;�VIU LA ACIL $ Ql'1ER THAN AUTO ONLY; AGG S EXCESWUPAWN-LALiAOILITY EK:H CCCURR6NCr- CCCUR MADE AGGROINrE --I-w7 lzT AITT-T---Crrg- 'AlORrt.liS CUMPENIkTION AND TO"l-ItArT3 FR E L.EACH C ACOENT !SICOOOO B AKY AWC7000033012006 05/08/07 0.41(Wou E.L.INSEME-FA L-MPLO'(--.F-$ 1.00000 I as dtxc6be ,-,dnr S CIAL PRO',;SIONS tk�P" R L.rISEAS1. POL!C.y Limrr s 50 o u 00 UTHER DU-4 R;P r 10 N 5F(iMN A V Qi4-FFL IA CERTIFICATE LDEP CANCELLATION SHOULD ANY OF THE ACUVC DESCRIBED PULIQIFU UE CANCELLED BEFORE THE EXPIRATION DATE Tl<nCOr!I IL 141,14ANQ INSURriR WILL rNDEAVOR 70 MAIL 30 UAYS WRITTEN NOTICE TO THE-VZATIFI;.ATr-HOLDER NAMED TO 7I•E LEFT,UW t FpjI.URF.70 Do SO SHALL Ted Towne dba Towrie. 11-uiArlarr, IMPOSC-NO OBLKJATIOINIQR LIA111LITY OF ANY KIND UPON THE IN!iUkEK,ITt A04%T4 OR 23 Lcudvillc Road _R--PRE 7NTATlYM Easthampton MA 01027 AUTHORMCD Tlrtva ACC)RD 25(2001M) 0 A -b-CoRpoRAT-idN I ,,,,, iU ,_UUI iUL. Ii-J`i T1lI r 11 11U. r. u b ACO CERTIFICATE OF LIABILITY INSURANCE 05/15/2 07 PR ,(413)566-0111 FAX (413)586-6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION )ftber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 North King Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR • g ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. Northampton, MA 01060 INSURERS AFFORDING COVERAGE NAIC 0 wsuRED Theodore Towne, Jr. INSURER A; NGM Insurance Company 14788 17A Gunn Road Extension INSURER a: WCAR CNA Southampton, MA 01073 INSURER C: INSURER P; INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO XHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF N18URANCE POLICY NUMBER POLICY EFFECTIVE POLK Y EXPIRATION LIMITS GENERAL LIABILITY MPI51046 06/2912006 06/29/2007 EACH OCCURRENCE i 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I$ SOO OO CLAIMS MADE OCCUR MEP EXP(Any one person) S 10.00 A PERSONAL&ADV INJURY i 11000,000 GENERAL AGGREGATE S 210001000 GEN'LAGOREOATELIMI7 APPLIES PER: PRODUCTS•COMPIOPAGG i 21000.00 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB ANY AUTO (Eeacsldent) S ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS IPer person) HIRED AUTOS BODILY INJURY i NON-OWNED AUTOS IPer atddanl) PROPERTY DAMAGE S IPBT att tIbnO GARAGE UAPILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHERTHAN EAACC S AUTO ONLY: AGG b EXCESSIUMBRRLLA LIABILITY EACH OCCURRENCE S OCCUR M CLAIMS MADC AGGREGATE L S DEOUC718LE' S RETENTION S S WORKERS COMPENSATION AND 6SS9UB7582A60206 07/07/2006 0710712007 X I WCsTArru I I Dnl EMPLOYERS'WABIUTY E,I.,EACH ACCIDENT $ 100,00 O B ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASG-EA EMPLOYEE S SDO,QO If ea,doacnbe under SPECIAL PROVISIONS below E,L,DISEASE-POLICY LIMIT I S 100'_000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFIC619 HOLDCR "ANCELL8JIQtj SHOULD ANY OF THE ABOVE DOSCRIBEO POLICIES BE CAMCBLLED BEFORE THE EXPIRATION DATE THEREOP,THE ISSUING INSURER WILL RNDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Charlene Towne BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 21 Loudvi l 1 e Road OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Easthampton, MA 01027 AUTHORIZED RIEPRESENTATIVE y �Jenna Rodri ue CISR/TER V ACORD 26(2001/05) CACORD CORPORATION 19811 1 '� � ° > .1'iteuse or registration valid for indil-idul use only b y. ` t bcfare the expiration date. If found rc.:::r.to: r wt b Board o:3.ilding Regulations and Standards >:.e Asl►h-:rton Place Rm 1301 :3oslon,Ma.02108 y _ / .�^'.✓ f + L (it 1•alid t,itltt ut silnanrrc r r 00-35,000 of enclosod space (MGL C.112 S.60L) 1 1A-Masonry only 1G-1 8 2 Family Homes Failure to possess a current edition of the ' Massachusetts State Building Code i • �) is cause for revocation of this license. t{ i ;r F -7233 DIG SAFE CALL CENTER: (888)344 ;a ter•�,���,f yP� x� b,'t r (.:� ✓�L(.'-CJO/JL//tONf.LH'lI,GUI, 0����ZU.JJ[GCl(-CIJ!'�C�` t F Board of Building Regulations and Standards r II ( HOME IMPROVEMENT CONTRACTOR �l Registration: 132751 Expiration: 4/2/2009 Tr# 129433 Type: Individual THEODORE TOWNE JR. THEODORE TOWNE 21 LOUDVILLE RD. EASTHAMPTON,MA 01027 Administrator `�_. a ✓/c �ai�tittuittue�ll/e r f;;fGc„rt�c�rt�eC(a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR °j Number: CS 000722 Birthdate: 08/20/1962 �.; J Expires: 08/20/2007 Tr.no: 2307.0 Restricted: 00 THEODORE D TOWNE JR 17 A GUNN RD EXT .:OUTHAMPTON, MA 01073 Commissioner / h(' l >u tom"�--.a_ �.._......�...,-.....a .....•...M,., BOARD OF BUILDING REGULATIONS k "== License: CONSTRUCTION SUPERVISOR =� Number: CS 000724 Birthdate: 09/24/1938, Expires: 09/24/2007 Tr.no: 3735.0 !'' Restricted: 00 THEODORE D TOWNE r 26 CHURCH ST f m'F w4 a EASTHAMPTON, MA 01027 Commissioner 9 f yl ) .35 0 cf enclosed space `{MGL C.112 S.60L) I A.-Masonry only IG- 3 2 Family Homes ailure to Possess a current edition of the ,lassachuselts Stale B of this f this Code s caul for revocation o license. �� DIG SAFE CALL CENTER: ($$$)344-7233 OgTtiAA1p�O Lzfy of j'art4a ptan z �833ACh128ttt9 DEPARTMENT OF BUILDlj\1G INSPECTIONS f INSPECTOR 212 Main Street • Municipal Building S, Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sup,,,,: sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed) insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signatur requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 6�� EZ6 Address of work location _�-46 ,e-, x /a __ ' • " The Commonwealth of Massachusetts Department of Industrial Accidents Office of.Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeZibly Name(Business/Organization/Individual): Address: City/State/Zip: �,��� °7� Phone.#: O F Dyou an employer?Check the appropriate box: Type of project(required): I am a employer with 4. X I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. F-1 Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.: 9. E]Building addition required.] 5. Fj We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 131J Other comp.insurance required.] any app scan a c ec ox mus a o ED out the section Relow showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: L) r1p Expiration Date: el ei" I Job Site Address: Q �_ �/ c c� City/State/Zip: 0 1 0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: S� C Phone#: 6;!' Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTIONS-CONSTRUCTION SERVICES e 8.1 Licensed Construction Supervisor: Not Applicable ❑ L Name of License Holder: C C2 7 �- 1 License Number Address Expiration Date Signature Telephone 9.Rectistered Floraee 1'moEOVeritent Confractar. _# - x Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone Z �j SECTION 10-WORKERS'COMPENSATION INSURANCE,AFFIDAVIT(M.G.L.c.1`52,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ l l.m-Harne Qwner le AE I on The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CN1R 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature_ ��� -�[*►T� � ✓ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. [l Demolition ❑ New Signs [O] Decks [M Siding[O] Other[o] Brief Description of Proposed Work: Alteration of existing bedroom Yes_ No Adding new bedroom Yes No x Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.if slid or actdr`tion to existing t onsil>�c 666i6lete:fhe-#allowli4 a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: _ Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Cp Dimensions X e. Number of stories? `jr� f. Method of heating? /f4 //� Fireplaces or Woodstoves—L Number of eachI�— g. Energy Conservation Compliance. ° //9 Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.of wetlands? Yes No. is construction wi i Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building �and ,Zoning regulations? �_Yes No. I. Septic Tank 4 City Sewer/Y/t _ Private well City water Supply_ SECTION 7a-OWNER AUTHORIZATION-T- O BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent herb declare that the sfa—temq6ts and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signatu o wnerlAgent Date __._ r ��: � ... ,_ ,,. *a� '�� ( RVC4 � �J �"s r� � � �, __� � � ��` __� U � � i �� � k .1 � \�` 1C �y ~- ._. �' _ _ _ _ _ `� ° ^ ` ^ w Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size a h Frontage Setbacks Front Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has Special Perm it/Vah e/Fi nd i been issued for/on the site? � IF YES, date issued: IF YES: Was the permit recorded mt the Registry ofDeeds? �� NO �� DON7 KNOW YES IF YES: enter Book / Page i and/or Document#� � �� �� B. Does the site contain a brook, body oy water orwetlands? NO K�� DON7KNOVV v_� YES �_� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtainad �~� 0btainmd �-� Date | ' �_/ ^+� ' � C. Do any signs exist on the property? ��� YES x`�/ NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES x�� NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,nrfi||ing)over 1 acre orioit part ofo common plan that will disturb over 1acre? YES K ) NO �y1 �� *� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. v Department use oniy; City of Northampton StatuefiPetlit �r Building Department -Curb�u-hWAe�ra� 212 Main Street Seweriepfickilabtht � � ' , Room 100 ater�Well AvaitabiLty � � phoneNorthampton, MA 01060 TwaSetsofStrcicturaT'Ptans 413--587-1240 Fax 413-587-1272 E Iotlsit Ptans - �` _ a Qther Specify .� - - APPLICATION TO,,gONSTRUC ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY,DWELLING SECTION 1 -SITE INFORMATION ` This section to be comptetetl by-office 1.1 Property Address: �zi0 l s�,1 ��� Map Lot Unit Zone Overlay District . Elie.St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED`AGENT 2.1 Owner of Record: Name(Print Current Mailing Address: c-crr r'C Telephone �- Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b).Estimated Total Cost of Construction_from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) rc Check Number �Of This Section For Offie'tal-Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date We A BP-2007-1257 p .. #'APPLICANT/CONTACT PERSON THEODORE D TOWNE ADDRESS/PHONE 23 LOUDVILLE RD EASTHAMPTON (413) 527-9060 Q Ilf- PROPERTY LOCATION 540 RYAN RD 2.q 461/CFct MAP 29 PARCEL 106 001 ZONE URA/( THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 4P 17 ot C-1 T_ypeof Construction: CONSTRUCT 22 X24 DET GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 000724 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,94ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Co on L Op- Signature of Building facial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. BP-2007-12.57 540 RYAN RD 540 #: COMMONWEALTH OF MASSACHUSETTS GIS Map:Blocl:: 29- 106 CITY OF NORTHAMPTON Lot: -001 Pemuti Building Category: BUILDING PERMIT Permit# BP-2007-1257 Protect# JS-2007-002008 Est. Cost: $22000.00 Fee: $79.20 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: THEODORE D TOWNE 000724 Lot Size(sq. ft.): 16291.44 Owner: TOWNE THEODORE&EVELYN M Zoning:,URA Applicant: THEODORE D TOWNE AT: 540 RYAN RD Applicant Address: Phone: Insurance: 23 LOUDVILLE RD (413) 527-9060 WC EASTHAMPTONMA01027 ISSUED ON:71312007 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 22 X24 DET GARAGE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: i House# Foundation: Driveway Final: Final: Final: ---� Rough Frame: P Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: -3 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA TIONS. Certificate of Occupancy.—� .,..-e X/`1 Si nature: FeeType' 'Date Paid: Amount: Building 7/3/2007 0:00:00 $79.20 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo